The Role of Self-Expandable Metallic Stents in the Treatment of Malignant Strictures in all Segments of the Gastrointestinal Tract.

Objectives: Management of malignant gastrointestinal (GI) obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. Self-expandable metallic stents (SEMSs) are used to provide permanent or temporary patency in all endoscopically accessible stenosis of the GI tract. In this study, it is aimed to analyse the characteristics and the efficacy of patients with malignant stenosis treated with SEMS, in all segments of the GI tract. Material and Methods: The sample consisted of 60 patients who underwent SEMS replacement, between 10 March 2014 and 16 December 2020, to treat malignant-related strictures in the GI tract at the Gastroenterology Department of the Health Sciences University Umraniye Training and Research Hospital. The data of the patients, hospital data processing database and electronic endoscopic database records were retrospectively scanned and recorded. The general characteristics of the patients and the treatment-related features were analysed. Results: The mean age of patients who were placed SEMS was 69.7 ± 13.7 years. Uncovered (15%, n: 9), fully covered (13.3%, n: 8), or partially covered (71.6%, n: 43) SEMS were successfully placed in all patients. Clinical success in patients with SEMS was 85.7% in the esophagus, 100% in the small intestine and 90.9% in the stomach and colon. About 11.4% migration, 14.2% pain, 11.4% overgrowth and 5.7% ingrowth were detected in patients who had SEMS placed in the oesophagus. Pain was detected in 9.1% and ingrowth in 18.2% of patients who had SEMS placed in the stomach. Pain was detected in 18.2% of the patients who had SEMS placed in the colon and migration was found in 9.1%. Conclusion: SEMS implant is a minimally invasive effective method in the palliative treatment of malignant strictures of the GI tract.

Does celiac disease impair coronary microvascular circulation: Coronary flow velocity reserve of patients with celiac disease.

BACKGROUND: Celiac disease (CD) is an enteropathy characterized with immune reaction to gliadin protein. AIM: In this study, we aimed to assess effect of CD on coronary microvascular circulation and the association between coronary flow velocity reserve (CFVR) and hs-CRP/Albumin ratio. MATERIAL AND METHODS: Study was conducted between March 2017 and November 2018 with CD at Umraniye Training and Research Hospital Gastroenterology Clinic. CFVR was defined as the ratio of hyperemic to baseline diastolic peak velocities. CFVR ≥ 2.0 was considered normal. C-reactive protein/albumin ratio (CAR) was calculated as hs-CRP/albumin. RESULTS: Serum albumin (4.27 ± 0.56 vs 4.50 ± 0.34; P value: .04) level was significantly lower in celiac group but higher Hs-CRP (2.44 ± 1.24 vs 1.82 ± 1.29; P value < .01), hs-CRP/albumin ratio (0.57 ± 0.30 vs 0.41 ± 0.31; P value: .03) were recorded in celiac group. Both hyperemic flow and CFVR substantially lower in the celiac group compared to controls. In univariate analysis; age, hs-CRP, and hs-CRP/albumin ratio were associated with low CFVR and hs-CRP/albumin level was an accurate predictor of low CFVR at the ROC curve. CONCLUSION: In this study, we found that in patients with CD, coronary flow reserve is impaired.

Irak-4 rs4251481 gene variant: as a risk factor on inflammatory bowel disease

Background/aim: Abnormal immune response occurs in individuals who have alleles associated with innate and adaptive immune mechanisms that predispose to inflammatory bowel disease (IBD). Interleukin-1 receptor-associated kinase 4 (IRAK-4) involved in the pathway produces cytokines that initiate and maintain inflammation through Toll-like receptors and interleukin-1 receptors on the membranes of innate immune cells are stimulated with antigens. It was aimed to investigate whether IRAK-4 rs3794262 and rs4251481 polymorphisms predispose to IBD and the possible effects of these polymorphisms by examining these gene polymorphisms with the clinic and prognostic parameters of IBD. Materials and methods: Real-time PCR technique was used to detect IRAK-4 polymorphisms in 107 patients with IBD and 103 healthy controls. Results: As a result of experimental studies, the frequency of occurrence of rs4251481 polymorphism related AG genotype (P = 0.029) and G allele (P = 0.005) was found to increase statistically in patients compared to controls. In the control group, the rs4251481 AA genotype rate of incidence increased compared with the patient group (P = 0.005). Conclusion: Consequently, this is the first study in terms of both polymorphisms on IBD. These results suggest that rs4251481 AG genotype and G allele are associated with increased IBD risk in patients.

Evaluation of Ischemia-Modified Albumin in Patients with Inflammatory Bowel Disease.

BACKGROUND: Inflammatory bowel disease (IBD) is considered a chronic gastrointestinal inflammatory disease with unknown etiology. Oxidative stress has been demonstrated to play a critical role in the pathophysiology of IBD. We aimed to investigate the effect of the ischemia-modified albumin (IMA) and CRP levels on the pathophysiology and activities of IBD and its subgroups. METHODS: The study included 39 patients with Crohn's disease (CD) and 41 patients with ulcerative colitis (UC). Thirty-three healthy volunteers participated in the study as the control group. The IMA concentrations were determined by colorimetric method. RESULTS: IMA levels were significantly higher in IBD than in the controls (p = 0.02). In the subgroups of IBD, IMA levels were significantly lower in the control group and CD group than in UC (p < 0.001 and p < 0.001, respectively) while IMA levels were significant higher in the UC when compared with the CD group (p < 0.001). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were significantly higher in the CD group compared to the control group (p < 0.01 and p < 0.02, respectively). CONCLUSIONS: Higher IMA level, which is a marker of oxidative stress in diseases with inflammation, indicates that inflammation and oxidative stress are related in the pathogenesis of IBD.

Efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori: a pilot study.

BACKGROUND: An ideal second-line therapeutic regimen for the treatment of patients who do not respond to standard triple therapy is currently being investigated. In this study, we aimed to investigate the efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori (H. pylori). MATERIALS AND METHODS: One hundred and forty eight consecutive H. pylori -positive patients who did not respond to the standard triple therapy (77 female, 71 male) were enrolled in the study. The patients were randomized consecutively to two-second-line therapy groups; 73 to the levofloxacin-containing sequential (LCS) and 75 to the levofloxacin-containing quadruple (LCQ) therapy group. The LCS therapy group received pantoprazole 40 mg and amoxicillin 1,000 mg twice daily for 5 days followed by pantoprazole 40 mg twice daily and metronidazole 500 mg three times daily and levofloxacin 500 mg one time daily for 7 days. The LCQ therapy group received pantoprazole 40 mg twice daily, tetracycline 500 mg four times daily, bismuth subcitrate 300 mg four times daily and levofloxacin 500 mg one time daily for 10 days. H. pylori eradication was confirmed by stool antigen testing at least 6 weeks after cessation of therapy. Side-effects and compliance were assessed by a questionnaire. RESULTS: Intention-to-treat cure rates were: 82.2% (95%CI; 73-91) and 90.6% (95%CI; 79-95) in the LCS and LCQ therapy, respectively. Per protocol cure rates were: 85.7% (95%CI; 75-92) and 93.1% (95%CI; 85-98) in the LCS and LCQ therapy, respectively. No statistically significant difference was found between two groups (p = .1). No differences in compliance or adverse effects were demonstrated between two groups. CONCLUSIONS: This prospective trial demonstrates that both levofloxacin-containing sequential therapy and levofloxacin-containing quadruple therapy regimens have higher H. pylori eradication rates and are well tolerated. The levofloxacin-containing quadruple therapy is likely the best treatment option for a second-line therapy, at least in the Turkish population.

Bone density in proton pump inhibitors users: a prospective study.

Patients with gastroesophageal reflux disease (GERD) receive long-term therapy with proton pump inhibitor (PPI) agents. Several studies have recently been published suggesting that treatment with PPI may cause bone fractures, although the number of prospective studies in this regard is limited. The aim of this study is to prospectively investigate the effect of PPIs on bone density. Between March 2009 and January 2011, 114 GERD patients (18-56 years) and 110 healthy controls were included in the present study. Bone mineral densitometry (BMD) by using dual-energy X-ray absorptiometry was assessed at lumbar spine and femur neck. BMD measurements were performed on all subjects at the beginning of the study. The patients were divided according to three drugs by their treatment with esomeprazole, lansoprazole, or pantoprazole. The study group was followed for at least 6 months on PPI therapy, and then BMD measurements were repeated. The mean duration of treatment with PPIs was 8.5 ± 2.3 months. In patients receiving PPIs, the mean reduction in total vertebra T score following treatment compared to pre-treatment values was 00.23 ± 0.42 units (95 % CI 0.15-0.30) (p < 0.01), while the mean reduction in the femur T score was 0.10 ± 0.40 units (95 % CI 0.03-0.18) (p = 0.03). Reduction following treatment in L4 and total vertebra T scores of lansoprazole group was significantly higher than of pantoprazole group (p = 0.04). Reduction in femur T score of esomeprazole group was higher than of lansoprazole group and pantroprazole group, but it is not statistically significant. Treatment with a PPI results in a significant reduction in bone density. Close monitoring is beneficial for patients who are to receive long-term treatment with PPI.

Prediction of Prognosis Acute Pancreatitis with Inflammatory Markers and Patient Characteristics Compared to the Scoring System: Real-Life Data.

Objectives: Acute pancreatitis (AP) is an inflammatory disease with a high morbidity and mortality rate. It is one of the most common causes of hospitalization among gastrointestinal system diseases. Inflammatory and other factors that predict the severity of AP are very important for patient management. This study will analyze the factors associated with the severity of AP. Methods: The sample consisted of 514 patients. Demographic characteristics, comorbid diseases, causes of AP, body mass index (BMI), tobacco use, blood at admission, amylase, lipase, leukocyte, neutrophil, lymphocyte, C-reactive protein (CRP), mean platelet volume, red cell distribution width, albumin, calcium, and CRP values at 48th h were recorded. The bedside index of severity in AP (BISAP), Ranson score, neutrophil-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) values was calculated and recorded. The relationship between these parameters and the severity of AP was analyzed according to the Atlanta classification. Results: Participants had a mean age of 55±17.8 years. More than half the participants were women (n=272, 52.9%). Biliary causes were the most common etiological causes (n=299, 58.2%). Most participants had mild pancreatitis (n=416, 80.9%). The severity of AP was associated with tobacco use, high BMI, thrombocytosis, high NLR, high PLR, high 48th h CRP, hypoalbuminemia, hypocalcemia, aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT ratio), and high Ranson and BISAP scores. Conclusion: Biochemical markers that give rapid results in the early period can provide information about the severity of AP. We may develop new scores by combining these parameters.

Portal vein thrombosis risk factors in liver transplant candidates.

Background and Aim: Portal vein thrombosis (PVT) is particularly detected in advanced liver cirrhosis patients. We aimed to analyze the risk factors for PVT in liver transplant candidates. Materials and Methods: Dataset for consecutive 165 cirrhotic patients who were evaluated for liver transplantation (LT) were retrospectively analyzed. We sorted patients into two groups: patients with PVT and patients without PVT. Included variables were age, sex, etiology of liver disease, body mass index, MELD-Na score, Child-Pugh score, clinical variables reflecting portal hypertension, and hepatocellular carcinoma. Univariate and multivariate logistic regression analyses were used to identify risk factors of PVT. Results: Of 165 LT candidates, 46 had PVT (27.9%). Ascites, thrombocytopenia, history of variceal bleeding, and band ligation were risk factors for PVT in univariate analysis. In multivariate analysis, only a history of variceal bleeding (OR 3.45, 95% CI 1.02-11.6, p=0.046) significantly increased the risk of PVT. Conclusion: The previous history of variceal bleeding predicts PVT development in cirrhosis, suggesting that the severity of portal hypertension is a major predictive factor for PVT in patients with cirrhosis. Future prospective studies are needed to risk stratifying cirrhosis patients prior to LT for future PVT development and to define the prophylactic role of anticoagulation in these patients.

Effects of Long-Term Tenofovir and Entecavir Treatment on Bone Mineral Density in Patients with Chronic Hepatitis B.

Background: We aimed to investigate the long-term effects of tenofovir disoproxil fumarate and entecavir treatment on bone mineral density and evaluated the fracture risk assessment tool score in patients with chronic hepatitis B. Methods: A total of 58 chronic hepatitis B patients treated with tenofovir disoproxil fumarate (n = 40) and entecavir (n = 18) were included in this prospective study from 2012 to 2016. To evaluate bone mineral density, dual-X-ray absorptiometry, fracture risk assessment tool, and laboratory examinations were performed in all patients first at baseline and second at the end of the study. Results: Age, sex, body mass index, fibrosis score, and viral load were similar in both groups. The mean follow-up was 33 months in the tenofovir disoproxil fumarate group and 31 months in the entecavir group. In patients treated with entecavir, there was no statistically significant difference between baseline and second bone mineral density including lumbar spine (L) and total hip T score. In patients treated with tenofovir disoproxil fumarate, there was a significant difference in the second bone mineral density compared with baseline bone mineral density for L3 (P = .033) and the major fracture risk assessment tool score (P = .03). When patients were divided into 3 groups (normal bone mineral density, osteopenic, and osteoporotic), there was a significant increase in the number of osteopenic patients in the total hip T score after tenofovir disoproxil fumarate treatment (P = .034). Conclusion: Our results suggest a decrease in the bone mineral density for lumbar spine (L3), an increase in the number of patients with hip osteopenia, and major fracture risk assessment tool score after long-term tenofovir disoproxil fumarate treatment in patients with rechronic hepatitis B.

EUS-FNA and ROSE in solid lesions of the pancreas; have the same diagnostic efficacy compared to pancreatic sites?

OBJECTIVE: Various techniques, needle types, and additional methods such as on-site pathological evaluation (ROSE) are used to increase the sensitivity of endoscopic ultrasound-fine needle aspiration (EUS-FNA), which is used in the diagnosis of pancreatic solid lesions. In this study, diagnosticity of the lesions according to the regions of the pancreas with EUS-FNA and ROSE performed with the slow pull technique using a 22 G needle will be evaluated. METHODS: A total of 82 patients who underwent EUS-FNA between January 2, 2015, and March 14, 2020, were included in the study. General and clinical information of the patients were recorded retrospectively. The patients were diagnosed according to The Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology Classification. If the diagnosis could not be made with EUS-FNA and ROSE, the diagnosis was made with alternative methods of surgery or percutaneous biopsy. Patients diagnosed as benign with EUS-FNA and ROSE were followed for at least 1 year and were accepted as benign. RESULTS: The mean age of the patients was 63.2±10.5 years and 54 (69.6%) of them were male. The mean lesion size was 36.8 mm and the number of needle passes was 2.87. The overall sensitivity was 82.9% and the specificity was 100%. The sensitivity of EUS-FNA and ROSE in solid lesions in the head and body of the pancreas was higher than in lesions in the tail region (p=0.024). CONCLUSION: EUS-FNA and ROSE are an effective method in the diagnosis of pancreatic solid lesions. The use of a 22 G needle may be more diagnostic in the head and body of the pancreas than in the tail region.

Post-ERCP Complication Analysis of an Experienced Center.

BACKGROUND/AIM: Post-ERCP pancreatitis (PEP), post-sphincterotomy bleeding (PSB), and Post-ERCP perforation are the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Identification of risk factors for post-ERCP complications is critical for postoperative follow-up. This study aimed to evaluate the most common post-ERCP complication risk factors in an experienced center. METHODS/DESIGN: The sample consisted of 1288 patients with naive papillae. Demographic characteristics, patient-related risk factors, procedure-related risk factors and postoperative complications were recorded. RESULTS: Patients had a mean age of 61.5±18.4 years. The prevalence of PEP, PSB, and post-ERCP perforation was 7.9%, 11.9%, and 0.5%, respectively. Among patient-related factors, female sex (OR 1.672 95% Cl 1.046 to 2.672) and narrowing of the choledochal diameter (OR 2.910 95% Cl 1.830 to 4.626) were associated with PEP. From procedure-related factors; precut sphincterotomy (OR 2.172 95% Cl 1.182 to 3.994), difficult cannulation (OR 5.110 95% Cl 2.731 to 9.560), pancreatic cannulation (OR 5.692 95% Cl 0.994 to 32.602) and postprocedure residual stone (OR 2.252 95% Cl 1.403 to 3.614) were found to be associated with PEP. The successful procedure (OR 0.378 95% Cl 0.204 to 0.699) had a protective effect on PEP. Choledocholithiasis indication (OR 3.594 95% Cl 1.444 to 8.942) and small papilla (OR 2.042 95% Cl 1.170 to 3.562) were associated with the development of PSB. Choledochal stenosis, periampullary-diverticulum, oral anticoagulant, and oral antiaggregant use were not associated with the development of PSB. Of the patients with post-ERCP perforation, 85.7% had difficult cannulation, 57.1% had precut sphincterotomy, and 28.6% had periampullary-diverticulum. CONCLUSION: Female sex, biliary stricture, precut sphincterotomy, difficult cannulation, pancreatic cannulation, and postoperative residual stone were associated with PEP. Choledocholithiasis indication and the presence of small papilla were associated with PSB.

Situs inversus totalis and secondary biliary cirrhosis: a case report.

Situs inversus totalis is is a congenital anomaly associated with various visceral abnormalities, but there is no data about the relationship between secondary biliary cirrhosis and that condition. We here present a case of a 58 year-old female with situs inversus totalis who was admitted to our clinic with extrahepatic cholestasis. After excluding all potential causes of biliary cirrhosis, secondary biliary cirrhosis was diagnosed based on the patient's history, imaging techniques, clinical and laboratory findings, besides histolopathological findings. After treatment with tauroursodeoxycholic acid, all biochemical parameters, including total/direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gama glutamyl transferase, returned to normal ranges at the second month of the treatment. We think that this is the first case in literature that may indicate the development of secondary biliary cirrhosis in a patient with situs inversus totalis. In conclusion, situs inversus should be considered as a rare cause of biliary cirrhosis in patients with situs inversus totalis which is presented with extrahepatic cholestasis.

The frequency of microscopic and focal active colitis in patients with irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. The frequency of microscopic colitis and focal active colitis in the colonic mucosa has been investigated in IBS patients. METHODS: Between June 2007 and September 2010, 378 patients (between 16 and 84 years) were recruited prospectively. Of these 378 patients, 226 patients were diagnosed with IBS using the Rome III criteria. 152 control patients were also enrolled who were undergoing colonoscopy for colorectal cancer screening or investigation of anemia. Histopathological abnormalities identified during colonoscopy were compared between the IBS and control groups. RESULTS: The average age of the IBS group was 46.13 ± 14.16 years and and the average age of the control group was 57.01 ± 13.07 years. The prevalence of microscopic colitis (MC) in the diarrhea predominant and the mixed subgroup of IBS patients was 4.32% (7/162) whereas in all IBS patients, the prevalence was 3.09% (7/226). MC was not found in the 152 control cases, (p = 0.045). Lymphocytic colitis was seen in 7 IBS patients, with 1 case in the mixed group and 6 cases in the diarrhea group and there was a significant difference in the frequency of lymphocytic colitis between the IBS subgroups (p < 0.01). Focal active colitis was found in 6.6% (15/226) of the IBS patients and in none of the controls (p < 0.01), and there was no differences between IBS subtypes. CONCLUSION: Microscopic colitis was more often found in the diarrhea predominant/mixed subgroups of IBS patients and in patients who were older women. In patients who are older woman with non-constipated IBS, it may be reasonable to perform a biopsy to screen for microscopic colitis. Focal active colitis was significantly increased in patients with IBS compared to controls.

Levofloxacin based sequential and triple therapy compared with standard plus probiotic combination for Helicobacter pylori eradication.

BACKGROUND/AIMS: Development of resistance to standard therapy for Helicobacter pylori (H. pylori) eradication is rapid. The aim of this study is to compare the efficacy of alternative treatment modalities for H. pylori. Compared treatments were standard triple treatment plus probiotic, sequential therapy with levofloxacin, and a 14-day regimen of PPI (proton pump inhibitor) and levofloxacin/amoxicillin combination. METHODOLOGY: Overall 285 patients were enrolled in the study and allocated into three groups. Group I (n=98) received lansoprazole, clarithromycin, amoxicillin and saccharomyces boulardii (probiotic) and group II (n=95) received esomeprazole, levofloxacin and amoxicillin for 14 days. Finally, group III (n=92) received esomeprazole and amoxicillin for five days, followed by esomeprazole, levofloxacin and metronidazole for seven days. Testing for H. pylori infection post-treatment was done using a stool antigen test five weeks after the completion of therapy. RESULTS: Patients in all three groups were treatment-naive. Response to treatment (Per Protocol/ITT analysis) was 77.1/72.4% in Group I, 89.1/86.3% in Group II, and 95.5% in Group III. Response to treatment was significantly higher in Groups II and III compared to Group I (p=0.03 and p<0.001, respectively). There was no difference between Groups II and III in terms of response to treatment (p=0.1). CONCLUSIONS: Levofloxacin-based sequential therapy and levofloxacin based triple therapy were significantly superior to standard triple therapy plus probiotic.

Ossified uncertain malignant potential gastric glomus tumor with tumor thrombus.

Glomus tumor is a rare mesenchymal tumor composed of perivascular glomus bodies. The most common presentation area of these tumors is peripheral soft tissue, particularly in the distal part of extremities. They rarely can occur in the gastrointestinal tract and the most common location is the stomach. Preoperative diagnosis of this tumor can be difficult because of rarity and overlapping features with other mesenchymal lesions with regard to clinical and pathological findings. Therefore, to exclude differential diagnosis and make a definitive diagnosis is possible only with histopathological examination. In this case, we evaluated glomus tumor of stomach according to 2019 WHO Digestive System Tumors and accurate diagnosed was Uncertain Malignant Potential Gastric Glomus Tumor.

Bone Mineral Density Screening and the Frequency of Osteopenia/Osteoporosis in Turkish Adult Patients With Celiac Disease.

BACKGROUND: The aim of this study was to evaluate the prevalence of osteopenia and osteoporosis in adult patients with celiac disease (CD) at diagnosis and/or in the follow-up after a gluten-free diet (GFD). METHODS: Adult patients diagnosed with CD were retrospectively screened through follow-up records and computer databases. Patients assessed by dual-energy X-ray absorptiometry (DEXA) at diagnosis and/or in the follow-up after a GFD were included in the study. RESULTS: One hundred patients who underwent a DEXA scan at least once after diagnosis or after being on a GFD were included in the study. The mean age of the patients at diagnosis was 34.61 ± 10.3 years, and 84% of the patients (n = 84) were female. At the time of diagnosis (n = 46), the prevalence of osteopenia and osteoporosis was 67.3% and 15.2%, respectively, at the lumbar spine, and 43.4% and 10.8%, respectively, at the femur. After a GFD (n = 78), the prevalence of osteopenia and osteoporosis was 61.5% and 8.9%, respectively, at the lumbar spine, and 37.1% and 2.5%, respectively, at the femur. CONCLUSION: The prevalence of CD patients with low bone mineral density (BMD) is high after diagnosis and in the follow-up after a GFD. It is important for all patients with CD to undergo a DEXA scan to determine the follow-up and/or treatment characteristics.

Polypoid lesions detected in the upper gastrointestinal endoscopy: A retrospective analysis in 19560 patients, a single-center study of a 5-year experience in Turkey.

OBJECTIVE: In our study, we aimed to evaluate the endoscopic features such as prevalence and localization of polypoid lesions determined by us using esophagogastroduodenoscopy and histopathological characteristics of biopsy specimens taken in detail. METHODS: The data of 19,560 patients undergoing upper gastrointestinal endoscopy for any reason between 2009 and 2015 in our endoscopy unit were screened retrospectively and endoscopic and histopathological findings were analyzed in detail. RESULTS: In our study, the polypoid lesion was detected in 1.60% (n=313) of 19,560 patients. The most common localization of the polypoid lesions was determined to be gastric localization (n=301, 96.2%) and antrum with a rate of 33.5% (n=105). When 272 patients in whom biopsy specimen could be taken was investigated, the most frequently seen lesion was polyp (n=115, 43.4%). Hyperplastic polyps (n=81, 29.8%) were the most frequently seen type among all polyps. In histopathological evaluation of the lesions, the prevalence rates of intestinal metaplasia (IM), surrounding tissue IM, atrophy, dysplasia, and neoplasia (adenocarcinoma, squamous cell carcinoma, gastrointestinal stromal tumor, neuroendocrine tumor, and metastatic tumor) among premalignant lesions were determined to be 16.9%, 11.2%, 4.1%, 1.1%, and 3.7%, respectively. CONCLUSION: Polypoid lesions can be seen in endoscopic investigations. In histopathological investigations, while the vast majority of these lesions are benign polyps, some of them are diagnosed as premalignant or malignant lesions. In our study, we determined malignant lesions higher than the similar studies in the literature. This condition shows how effective endoscopic procedure and histopathological evaluation are of vital importance.

Current prevalence of intestinal metaplasia and Helicobacter pylori infection in dyspeptic adult patients from Turkey.

BACKGROUND: The aim of this study was to investigate the prevalence of Helicobacter pylori (H. pylori) infection and intestinal metaplasia in adult dispeptic patients. (attending an endoscopy clinic at our training and referral hospital in Turkey). METHODOLOGY: A total of 3301 consecutive dyspeptic patients, with a mean age +/- SD of 45.97 +/- 15.15 years, had two antral and two corporal biopsies, during routine upper gastrointestinal endoscopy. Patients were divided into three groups according to age; 18-40 years old, 41-60 years old and over 60 years old. Histological specimens were examined and graded according to the Updated Sydney System for H. Pylori infection and intestinal metaplasia. RESULTS: H. pylori was established in 2353 patients (71.3%). Intestinal metaplasia was found in 586 patients (17.8%). Of these patients, 86% (n:504) had complete and 14% (n:82) had incomplete intestinal metaplasia. Frequency and severity of H. pylori infection decreased significiantly in the older group (p < 0.001). Patients with intestinal metaplasia were older (53.6 +/- 14.9 years) than patients without intestinal metaplasia (44.3 +/- 14.7 years) (p < 0.001). There was no statistically significant relationship between intestinal metaplasia and H. pylori presence (p > 0.05). Intestinal metaplasia was more prevalant in patients with mild infection (21.9%) than in patients without Helicobacter pylori infection (16.3%) or with moderate (16.2%) or severe infection (14.6%) (p < 0.01) CONCLUSION: H. pylori infection and density decreases, while the prevalence of intestinal metaplasia and incomplete intestinal metaplasia percentage increases in older dyspeptic patients. Mild H. Pylori colonisation could be a sign of intestinal metaplasia, especially in the elderly.

The role of FAS gene variants in inflammatory bowel disease.

BACKGROUND/AIMS: The analysis of genes thought to be important in inflammatory bowel disease (IBD) has shown that more than half of IBD-related genes are also associated with other autoimmune diseases. The aim of this study was to detect a possible association between the polymorphisms of the (-670 A/G, -1377 G/A) fFas cell surface death receptor (FAS) gene promoter and susceptibility to IBD in the Turkish population. MATERIALS AND METHODS: In total, 125 patients with IBD, including 73 ulcerative colitis and 52 Crohn's disease and also 101 healthy controls without any pathological signs of IBD were considered for the study. Real-time polymerase chain reaction technique was used to detect FAS polymorphisms in this study. RESULTS: The analysis of FAS -670 A/G polymorphism indicated that the frequency of GG genotype was significantly increased in patients compared with controls (p<0.001). Additionally, AG genotype (p<0.001) and A allele (p<0.001) frequencies were higher in controls than in patients. The analysis of FAS -1377 G/A polymorphism revealed that the frequency of AA genotype was meaningfully increased in patients compared with controls (p<0.001). Additionally, GG genotype (p<0.001) and G allele (p<0.001) frequencies were increased in controls when compared with patients. CONCLUSION: FAS -670A/G GG genotype seemed to be a protective allele against IBD; however, AA genotype and A allele were associated with elevated risk of IBD. In the FAS -1377G/A polymorphism, frequencies of the G allele and GG genotype were observed to be protective against IBD, whereas AA, GA genotypes, and A allele frequency increased in the patient group.